The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high-risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.

Summary: Ruc~ltgroiintl:The purpose of ncuroiniaging of a patient with new onset of seizures is to demonstrate cause and explore thc prognosis. It was recently recommended that eincrgcncy brain coinputcd tomography (CT) be performed only in adult seizure patients with an increased likelihood of lifethreatening lesions, i.c., those with new focal deficits, persistent altcred mental status, lever, recent trauma, persistent headaches, history of cancer, history of anticoagulation, or suspicion of acquired immunodcl'iciency syndrome. The objective of this study was to determine the diagnostic utility of emergency brain CT in children who present to (he emergency deparlment with new onset of seizures.Methods: A I -year retrospective chart review of all children who presented lo thc emergency department of the Schneidcr Children's Hospital with a new onset of seizures and who underwent CT of the brain, excluding children with simple febrile scimrcs.Kesiilts: Sixty-six patients, 34 boys and 32 girls with a mean age of 4.9 years, qualified for inclusion in the study. Fifty-two patients (78.8%) had normal C T results and 14 patients (21.2%) had abnormal CT results. Seizure cause was considered cryplogenic i n 33 patients, of whoin 2 (6%) had abnormal CT results; ncither patient required intervention. Seizure cause was considered symptomatic in 20 patients, of' whom I2 (60%~) had abnormal CT results (p < 0.0001). In two patients with abnormal CT scans (both acutc symptomatic), the imaging findings were of immediate therapeutic significance and were predictable from the clinical history and the physcial examination. None of the 13 patienls with complex febrile seizure ciiusc had an abnormal CT scan. Patients with partial convulsive seizures were more likely to have abnormal CT scans than paticnts with generalized convulsive seizures, but the difference was not statistically significant.Conclusions: The routine practice in many pediatric emcrgency departments of obtaining brain CT scans for all patients with ncw onset of nonfebrile seizures is un.justified. History and physical examination are sufficient to identify those patients for whom such studies arc likely to be appropriate. Emergent CT is not indicated for patients with no known seizure risk factors, normal neurological examinations, no acutc symptomatic cause other than fever, and reliable neurological follow-up. For these patients, referral to a pediatric neurologist I'or further workup, including electroencephalography and the more diagnostically valuable magnetic resonance iinaging, would be more appropriate. Key Words: Seizure diagnosis-CT scanEmergency department.Adults and children presenting to emergency departments (EDs) with a new onset of seizures are often evaluated with computed tomography (CT) ( 1-4). Previous neuroradiological studies have demonstrated that approximately one-third of children with epilepsy have CT abnormalities (5-7); however, fewer than 3% of these